Provider Demographics
NPI:1861032179
Name:NEWPORT BEACH PEDIATRIC PULMONOLOGY, INC.
Entity Type:Organization
Organization Name:NEWPORT BEACH PEDIATRIC PULMONOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:NEVIN
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-220-0510
Mailing Address - Street 1:369 SAN MIGUEL DR STE 375
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7847
Mailing Address - Country:US
Mailing Address - Phone:949-220-0510
Mailing Address - Fax:
Practice Address - Street 1:369 SAN MIGUEL DR STE 375
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7847
Practice Address - Country:US
Practice Address - Phone:949-220-0510
Practice Address - Fax:949-220-0509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty